Breast Cancer

Breast cancer is the disease many women fear the most. It is the second most common cancer among women, with about 192,000 new cases each year. It remains the leading cause of death of women between ages 40 and 55. While known primarily as a woman's disease, men also develop breast cancer.

The good news is that survival rates today are higher than ever due to advances in diagnosis and treatment. At the UCSF Carol Franc Buck Breast Care Center, emphasis is placed on screening for early detection, more effective and less toxic therapies, patient education, and research that explores the causes, biology and behavior of the condition for future prevention and treatment strategies.

The Breast Care Center works to heal the whole person, both your physical and emotional being. We provide services including individual counseling and support groups that focus on every stage that you and your family may experience, where patients share their stories.

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Breast cancer begins with abnormal cells developing in breast tissue. It can be confined to the breast or may spread beyond your breast or into other parts of your body. The most common type of breast cancer begins in the ducts designed to carry milk to the nipple. But cancer also may occur in the small sacs that produce milk, called lobules, or in other breast tissue. Breast cancer varies widely and the treatment options are selected to match your individual needs.

Types of Breast Cancer

Breast cancer may occur in several different forms, such as the five types below:

Breast Cancer in Situ, DCIS and LCIS — Many breast cancers detected early, typically by mammography, are classified as breast cancer in situ or noninvasive cancer. These early cell changes may develop into invasive breast cancer. Two types of breast cancer in situ are:

DCIS (ductal carcinoma in situ) means that abnormal cells are found only in the lining of a milk duct of the breast. These abnormal cells haven't spread outside the duct. There are several types of DCIS. If not removed, some may change over time and become invasive cancers, while others may not. DCIS is sometimes call intraductal carcinoma.

LCIS (lobular carcinoma in situ) means that abnormal cells are found in the lining of a milk lobule. Although LCIS is not considered to be actual breast cancer at this noninvasive stage, it is a warning sign of an increased risk of developing invasive cancer. LCIS sometimes is found in a biopsy for another lump or unusual change detected on a mammogram.

Invasive Breast Cancer — These cancer cells form in the ducts or the milk lobules and spread to the breast tissue around them. Tumors can be found during a breast exam or through screening, such as a mammogram. The size of the tumor, what it looks like under the microscope and whether it has spread to the lymph nodes determines the severity of the cancer, the therapies and the difference treatments will make.

Metastatic Breast Cancer — Metastatic cancer begins in the breast, but spreads outside the breast through the blood or lymph system to other organs. Women usually develop metastatic disease in the months or years following the diagnosis of breast cancer. This cancer most commonly spreads beyond the breast to a patient's bones, lung, liver and brain.

Locally Advanced Breast Cancer — Inflammatory breast cancer is a rare but very serious and aggressive type of breast cancer. The breast may look red and feel warm. A patient may see ridges, welts or hives on the breast or its skin may look wrinkled. It is sometimes misdiagnosed as an infection.

Recurrent Breast Cancer — Recurrent disease means that the cancer has come back or recurred after treatment. It may come back in the breast, in the soft tissues of the chest or chest wall, or in another part of the body.

Early breast cancer usually doesn't cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it may cause changes that you should watch for:

A lump or thickening in or near the breast or in the underarm area

A change in the size or shape of the breast

Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast

Ridges or pitting of the breast, making the skin look like the skin of an orange

A change in the look or feel of the skin of the breast, areola or nipple such as warmth, swelling, redness or scaliness

If cancer is found in your breast, your doctor will assess the stage or extent of the disease. Staging is an effort to determine if the cancer has spread and, if so, to what parts of the body. Your doctor may use blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings. Read Staging: Specific Patterns of Breast Cancer to learn more about the staging system.

The first step is usually a physical exam by a doctor or nurse practitioner. Mammography and ultrasound may be part of the exam. On the basis of these evaluations, the decision may be made to perform a tissue biopsy.

Imaging

Imaging is used to diagnose breast cancer and to evaluate the stage and extent of disease. Three types of imaging are used — mammography, ultrasonography and breast magnetic resonance imaging (MRI). Based on these exams, your doctor may recommend further tests or therapy, or determine that not treatment is necessary.

Treatments for breast cancer include surgery as well as radiation, chemotherapy and hormonal therapy. These treatments are either local or systemic. Local treatments, such as surgery and radiation therapy, remove, destroy or control cancer cells in specific areas. Systemic treatments, such as chemotherapy and hormonal therapy, destroy or control cancer throughout the body. Depending on your condition, you may receive one treatment or a combination at the same time or in succession.

Surgery

Surgery is a common treatment for cancer. Several procedures may be used, from lumpectomy to breast reconstruction:

Lumpectomy — In this procedure, a surgeon removes the cancer and some normal tissue around it. Lumpectomy usually results in little change in breast appearance. Some lymph nodes may be removed from under your arm to determine if cancer has spread. Radiation therapy is typically performed to destroy any cancer cells that may remain.